ESC: ECG Not Much Help for Screening Athletes' Hearts

Action Points

Point out that although hypertrophic cardiomyopathy is the most common cause of sudden death in athletes, it is a rare condition.

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

STOCKHOLM -- While hypertrophic cardiomyopathy is the most common cause of sudden death in competitive soccer players, when pro players were screened for the problem with electrocardiography (ECG), the positive results all turned out to be false positives, according to a small study.

In an abstract scheduled for presentation here at the European Society of Cardiology (ESC) annual meeting, the researchers indicated that recommendations for routine ECG-based screening of athletes "should be reevaluated."

Some earlier studies, particularly from Italy, had indicated that 12-lead ECG screening could identify athletes with hypertrophic cardiomyopathy, putting them at risk for sudden cardiac death. Making such screening routine in Italy was said to reduce cardiac arrests among athletes by 90%.

However, the new Spanish study suggests that instituting such screening may also involve a great deal of waste -- since positive findings typically result in expensive follow-up evaluations.

Cabrera and colleagues reported on their experience with 30 professional soccer players, mean age 31 (SD 4), who underwent 12-lead ECG screening conducted and interpreted according to proposed ESC guidelines.

The participants also underwent MRI cardiac scans and genotyping for mutations in nine genes known to be associated with various types of heart disease.

ECG results in 17 of the players showed abnormalities that, under the guidelines, were indicative of cardiac hypertrophy warranting follow-up.

But the MRI results in all 17 showed normal left ventricular wall thickness and no signs of systolic anterior mitral valve motion or left ventricular outflow obstruction.

On the other hand, the evaluations failed to identify minor pericardial effusion in two players and persistent ductus arteriosus in another.

None of the participants had risk-associated genotype findings.

Alfred Bove, MD, of Temple University in Philadelphia and past president of the American College of Cardiology, told MedPage Today in an interview that the findings are plausible but at the same time pose a conundrum for clinical practice.

"It's a tough call," he said. "How do you find these kids [with serious cardiac abnormalities]? It's very small numbers, one in 100,000 or something like that. How many do you screen with expensive tests to find the one kid -- it becomes a big issue."

He noted that ECG screening is relatively cheap and easy to perform, and there is nothing else available for mass use that would not cost substantially more.

But Bove agreed that relying on ECG causes problems, particularly in the U.S. where rates of actual cardiac abnormalities are much lower than in northern Italy, where the research underlying the current recommendations was conducted.

"The Italians have convinced the world that everybody should have an electrocardiogram," he quipped.

Bove, who said he sometimes helps evaluate young athletes with suspected heart problems, indicated that, as a result, it's common to see one athlete "with a very bizarre-looking electrocardiogram -- perfectly normal kid, playing excellent sports, no history of anything ... and everybody gets all upset."

He said these athletes can get "million-dollar workups" that, most times, show nothing abnormal other than the "weird" ECG.

No external funding for the study was reported.

Cabrera had no conflict of interest disclosures.

Bove said he had no relationships with commercial entities relevant to the research.

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